Mortality Burden for Patients with Untreated Aortic Regurgitation

“This research underscores the poor outcomes for patients with moderate AR who exhibit cardiac damage, stressing the need to monitor for distinct characteristics in this population. These insights may also prompt a reassessment of our management strategies and suggest a shift in our approach to intensified follow-up for both moderate and severe AR patients.”
Philippe Généreux, MD, FACC Director of the Structural Heart Program at Morristown Medical Center’s Gagnon Cardiovascular Institute and lead author of the study.

BACKGROUND

Aortic valve replacement (AVR) is indicated in patients with severe aortic regurgitation (AR). However, certain clinical predictors may identify patients with less-than-severe AR at high mortality risk if untreated.

METHODS

We analyzed patients >18 years of age with documented AR assessment in a deidentified real-world dataset from 27 US institutions with appropriate permissions (egnite Database; egnite, Inc). Diagnosed AR severity was extracted using a natural language processing-based algorithm. Cox multivariable analysis modeled the impact of key factors on untreated mortality according to AR severity.

RESULTS

81,378 patients were included for analysis. Hazard ratios (95% CI) for mortality were 1.26 (1.18-1.35) and 2.37 (1.96-2.87) for moderate and severe AR, respectively. Other significant predictors included left ventricular (LV) ejection fraction ≤55% (1.09 [1.02-1.15]), LV dilation (1.34 [1.21-1.48]), left atrial (LA) dilation (1.09 [1.03-1.16]), atrial fibrillation (1.11 [1.04-1.17]) and high B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide (1.71 [1.60-1.84]). Modeled mortality risk increased with the presence of these key predictors, either alone or in combination.

CONCLUSIONS

In patients with untreated AR, LV and LA remodeling and other cardiac damage predict mortality, both for severe and moderate AR. Further study is needed to determine whether AVR might be warranted in patients with less-than-severe AR with at-risk factors.

Généreux P, et al. Moderated abstract presentation at: American College of Cardiology 73rd Annual Scientific Session & Expo (ACC.24); April 6-8, 2024; Atlanta, GA.

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